Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Previous JSA Review

  • Has the previous JSA been reviewed?

  • Are there unresolved issues remaining?

  • What issues need to be resolved?

Site

  • Has a JSA been completed?

  • Has everyone signed the JSA?

  • Is site clean and organized?

  • Are there unrecognized hazards present?

  • Are vehicles chocked and pointd toward the exit?

  • Are trenches and excavations protected?

  • Was One Call contacted?

  • Is LOTO being utilized?

Hazardous Chemicals

  • List of hazardous chemicals available?

  • Material Safety Data Sheets available?

  • Proper containers used with correct labeling?

First Aid

  • Is Eye Wash available?

  • Is First Aid Kit available and stocked?

  • Is at least one employee trained in First Aid / CPR on site?

  • Other observations

Vehicles

  • Are fire extinguishers present, charged, and the correct size?

  • Is vehicle in good condition?

  • Is vehicle DOT compliant?

  • Is the vehicle clean inside?

  • Is the vehicle clean outside?

  • Is there damage to the vehicle?

  • Are the tires good?

  • Vehicle Unit Numbers

Personal Protective Equipment

  • Are employees wearing correct eye protection?

  • Hard hats?

  • Steel toed boots?

  • Fire resistant clothing?

  • Hearing protection?

  • H2S Detector?

  • Fall Protection?

  • Is all PPE in good condition and clean?

Mobile Equipment

  • Is equipment damaged?

  • Cab clean and free of litter?

  • Seatbelts worn?

  • Being used correctly?

  • Does equipment require certification or specialized training?

  • Is operator qualified?

  • Are attachments in good working order?

  • Is equipment and attachments being utilized correctly?

  • Is equipment being serviced and maintained correctly?

  • Equipment Numbers

Tools

  • Are tools in proper working order?

  • In good condition?

  • Are electrical cords in good shape?

  • Are accessories/attachments in good shape?

  • Are tools being utilized correctly?

  • Is proper tool being utilized?

Trailers

  • Is trailer being pulled by correct vehicle?

  • Has this vehicle been DOT'd?

  • Is trailer Annual Inspection up to date?

  • Is there damage to trailer?

  • Trailer Unit Numbers

Comments / Observations

  • What follow up is required?

  • Comments, Concerns, Reccomendations

Reviewed by:

  • Site Supervisor

  • Safety Representative

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.